EDGE - Registration

                                      

 

 

 

 

 

 

 

Participant Information
Youth Name
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NickName
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Date of Birth //
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Sex
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Grade
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School
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Address
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Expected High School Graduation Year
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T-Shirt Size (Adult)
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EXTRACURRICULAR ACTIVITIES
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Parent/Guardian Information
Mail should be addressed to:
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Other (Specify)
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FATHER FATHER'S INFORMATION
Name
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Phone --
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Address
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E-mail
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MOTHER MOTHER'S INFORMATION
Name
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Phone --
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Address
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E-mail
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REGISTERED AT:
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PLEASE SPECIFY WHAT PARISH YOU ARE REGISTERED AT:
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EMERGENCY CONTACT INFORMATION
In case of an emergency whom should we contact if we are unable to reach parent/guardian?
Name
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RELATIONSHIP
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Phone --
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Name
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RELATIONSHIP
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Phone --
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HEALTH INFORMATION AND SPECIAL NEEDS
All information will be held in strict confidence
DOCTOR'S NAME
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Phone --
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INSURANCE COMPANY NAME
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MEDICAL INSURANCE ID #
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CARDHOLDERS NAME
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GROUP NUMBER
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PARTICIPANTS ALLERGIES
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PARTICIPANTS CHRONIC MEDICAL PROBLEMS
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PARTICIPANTS OTHER PHYSICAL RESTRICTIONS
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OTHER NOTES
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PARENT/GUARDIAN DUTIES
WE NEED ADULT VOLUNTEERS!
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PHOTOGRAPHY CONSENT
PHOTOGRAPHY CONSENT As parent/guardian, I understand that photos and video (individual and group) will be taken during youth group events, and I give permission for my son's/daughter's picture to be used for printed or online promotional materials
PHOTOGRAPHY CONSENT
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LIABILITY WAIVER
I agree on behalf of myself, my child’s other parent if known or living, my child named herein, our heirs, successors, and assigns, to release and hold harmless and defend the Diocese of Corpus Christi, St. Philip the Apostle Catholic Church (its pastors, youth minister, principal, other agents, etc.) or any representatives associated with any ongoing scheduled activities from all damages, claims, suits, expenses and payments for injury to my child and/or property, including all damages, claims, suits, expenses and payments resulting from the negligence of the Diocese of Corpus Christi, St. Philip the Apostle Catholic Church, and/or their officers, directors and employees. This liability waiver is effective from date of signature to June 1,2023.
LIABILITY WAIVER
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Date //
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Spam Capture
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